Bacteremia and sepsis by Arcanobacterium haemolyticum in a young immunocompetent patient / Bacteriemia y sepsis por Arcanobacterium haemolyticum en un paciente joven inmunocompetente

Abstract We report the case of a twenty-year-old immunocompetent male patient presenting to the emergency room with pharyngitis and fever. Blood cultures were drawn and Arcanobacterium haemolyticum (rough biotype) was recovered. The presence of the arcanolysin gene was investigated at the molecular level and the upstream region was amplified and sequenced in order to correlate it with the smooth or rough biotype. Although the isolate was susceptible to penicillin, vancomycin and gentamicin, empirical treatments first with amoxicillin/clavulanic acid (1g/12h) and then with ceftriaxone (1g/12h) failed and the infection evolved to sepsis. Finally, treatment with vancomycin (1 g/12 h) plus piperacillin/tazobactam (4.5g/8h) was effective. Lemierre's syndrome was ruled out. To the best of our knowledge, this is the first case of bacteremia by A. haemolyticum reported in Argentina.

Resumen Se describe el caso de un paciente varón inmunocompetente de veinte anos de edad que se presentó en la sala de emergencias con faringitis y fiebre. Se extrajeron muestras para realizar hemocultivos y se recuperó Arcanobacterium haemolyticum (biotipo rugoso). Se investigó la presencia del gen de la arcanolisina por un método molecular, y se amplificó y Faringitis; secuenció la región upstream de dicho gen para determinar su correlación con los biotipos lisos Bacteriemia; o rugosos. Aunque el aislamiento fue sensible a la penicilina, la vancomicina y la gentamicina, Sepsis; los tratamientos empíricos primero con amoxicilina/ácido clavulánico (1 g/12 h) y luego con Síndrome de Lemierre ceftriaxona (1 g/12 h) no fueron efectivos, y la infección evolucionó a sepsis. Finalmente, el tratamiento con vancomicina (1 g/12 h) más piperacilina/tazobactam (4,5g/8h) fue efectivo. Se descartó la presencia del síndrome de Lemierre. Según nuestro conocimiento, este es el primer caso de bacteriemia por A. haemolyticum reportado en Argentina.

Epidemiología de la faringitis aguda bacteriana en un hospital general de agudos / Epidemiology of acute bacterial pharyngitis in a general acute care hospital / Epidemiologia da faringite bacteriana aguda em um hospital geral de cuidados agudos

La faringitis aguda bacteriana (FAB) representa entre un 20 a 30% de las faringitis. El principal agente causal es Streptococcus pyogenes. Se revisó retrospectivamente la información microbiológica disponible entre 2010 y 2016, para analizar la incidencia de la FAB, sus agentes causales, la incidencia de casos según el período estacional y rango etario. Se determinó el porcentaje de resistencia (R) de S. pyogenes a eritromicina y el fenotipo predominante. Se diagnosticó FAB en 21,5% de 3.246 cultivos, donde 89% fueron causados por S. pyogenes. El 35,3% de las FAB se presentó en niños de 7 a 10 años, seguido por el grupo de mayores de 15 años (31,3%). Se evidenció un aumento de faringitis por Streptococcus dysgalactiae subsp. equisimilis en 2011 y 2014; 56,2% de los casos se diagnosticaron en mayores de 15 años. Hubo 3 casos de FAB por Arcanobacterium haemolyticum. El 36,1% de las faringitis se presentaron en primavera, con un aumento significativo durante las correspondientes a 2010 y 2016. La R global a eritromicina en S. pyogenes fue del 16,6% con predominio del fenotipo M. El valor de R encontrado fue superior al ser comparado con otras estadísticas similares, lo que demostró la importancia de monitorear este dato, dado que es el antibiótico alternativo en pacientes alérgicos a penicilina.

Acute bacterial pharyngitis (ABP) accounts for 20 to 30% of acute pharyngitis. The most common bacterial agent is Streptococcus pyogenes. A retrospective, record-based study was carried out based on the microbiological records from 2010 to 2016, analyzing ABP's incidence, its causal agents and its incidence according to the season and age range. Erythromycin resistance and the main resistance phenotype were determined in S. pyogenes. Acute bacterial pharyngitis was diagnosed in 21.5% out of 3.246 cultures, 89% were due to S. pyogenes, 36.3% of patients were children between 7 to 10 years old and 31.3% were older than 15 years of age. There was a significant increase in pharyngitis due to Streptococcus dysgalactiae subsp. equisimilis since 2010 (p<0.05), 52.5% were detected in patients older than 15 years of age. There were only three cases of ABP produced by Arcanobacterium haemolyticum. A total of 36.1% of pharyngitis occurred during spring, with a significant increase during 2010 and 2016 springs. Global erythromycin resistance in S. pyogenes was 16.6% with predominance of the M phenotype. This resistance rate is higher than that described in other similar series, demonstrating the importance of continuously monitoring of macrolide R in S. pyogenes, since they are the antibiotics of choice to treat pharyngitis in patients allergic to penicillin.

A faringite bacteriana aguda (FAB) representa entre 20 e 30% das faringites. O principal agente causador é Streptococcus pyogenes. Foi revista retrospectivamente a informação microbiológica disponível entre 2010 e 2016, para analisar a incidência da FAB, seus agentes causadores, a incidência de casos de acordo com o período sazonal e a faixa etária. A percentagem de resistência (R) de S. pyogenes à eritromicina e ao fenótipo predominante foram determinadas. Foi diagnosticado FAB em 21,5% de 3,246 culturas, 89% das quais foram causadas por S. pyogenes. 35,3% das FAB se apresentou em crianças de 7 a 10 anos, seguidas pelo grupo de mais de 15 anos (31,3%). Houve aumento de faringite por Streptococcus dysgalactiae subsp. equisimilis em 2011 e 2014; 56,2% dos casos foram diagnosticados em jovens de mais de 15 anos. Houve 3 casos de FAB por Arcanobacterium haemolyticum. 36,1% das faringites ocorreu na primavera, com um aumento significativo em 2010 e 2016. A R global a eritromicina em S. pyogenes foi de 16,6% com prevalência do fenótipo M. O valor de R encontrado foi superior em comparação com outras estatísticas semelhantes, demonstrando a importância de monitorar esse dado, pois é o antibiótico alternativo em pacientes alérgicos à penicilina.

Unusual caudal vena cava thrombosis in a cow, secondary to Trueperella (Arcanobacterium) pyogenes infection / Rara trombose da veia cava caudal em bovino, secundária à infecção por Trueperella (Arcanobacterium) pyogenes

The caudal vena cava thrombosis, or pulmonary thromboembolism, in cattle is correlated with lactic acidosis, caused by diets rich in grains and highly fermentable, associated or not to septic situations, used in feedlots of beef or high-producing dairy cattle. This paper reports an unusual caudal vena cava thrombosis in a cow, secondary to Trueperella (Arcanobacterium) pyogenes infection, resulting in reduced milk production, anorexia, pale mucous membranes, ruminal atony, sternal decubitus and autoauscultation position. The heart was enlarged at necropsy, presence of clots distributed along the thoracic cavity, adherence between lung and pleura, abscesses, emphysema, petechiae, suffusions and ecchymosis in lungs, thickening of the caudal vena cava wall, hepatomegaly with chronic passive congestion ("nutmeg" aspect), and rumenitis. In lab, the actinomycete Trueperella (Arcanobacterium) pyogenes was isolated from liver and lung samples, probably resulting through dissemination of the bacteria of the rumen content, what reaffirms the opportunistic behavior of this actinomycete.(AU)

A síndrome da veia cava caudal ou tromboembolismo pulmonar bovino está relacionada à acidose láctica causada por dietas ricas em grãos e altamente fermentáveis, associados ou não a quadros sépticos, usadas em confinamentos de bovinos de corte ou para vacas leiteiras de alta produção. O presente artigo reporta caso raro de trombose da veia cava caudal em uma vaca, secundária a infecção por Trueperella (Arcanobacterium) pyogenes, apresentando reduzida produção de leite, anorexia, palidez de mucosas, atonia ruminal, decúbito esternal e posição de autoauscultação. À necrópsia observou-se coração aumentado de tamanho, coágulos distribuídos por toda cavidade torácica, aderência entre os pulmões e pleura, abscessos, enfisema, petéquias, sufusões, equimoses nos pulmões, espessamento da parede da veia cava caudal com trombo, hepatomegalia com congestão passiva crônica (aspecto de "noz moscada"), e ruminite. Em laboratório isolou-se o actinomiceto Trueperella (Arcanobacterium) pyogenes a partir de amostras de fígado e pulmão, provavelmente resultando da disseminação da bactéria proveniente do conteúdo ruminal, e reafirma o comportamento oportunista deste actinomiceto.(AU)

A Case of Diabetic Foot Ulcer Caused by Arcanobacterium haemolyticum and Streptococcus agalactiae / 대한임상미생물학회지

Arcanobacterium haemolyticum, a aerobic Gram-positive rod, has been described as an unusual pathogen causing soft tissue infections such as pharyngotonsillitis, chronic ulcer and cellulitis. In addition, the microorganism causes deep-seated infection and systemic disease including endocarditis, vertebral osteomyelitis and sepsis in patients with predisposing conditions such as diabetes mellitus. Since colonies and microscopic findings of A. haemolyticum might be confused with those of streptococci and coryneform bacteria, and it is usually isolated with other microorganisms, it is often considered to be normal flora or a contaminant in wound infections, resulting in missed or delayed diagnosis. Streptococcus agalactiae infections in neonates and pregnant women have been well recognized. However, invasive S. agalactiae infections in non-pregnant older adults with chronic medical conditions, particularly diabetes mellitus, are increasing. We report a case of diabetic foot ulcer due to A. haemolyticum and S. agalactiae in an uncontrolled diabetes mellitus patient.

Two Cases of Invasive Infections Caused by Arcanobacterium haemolyticum in Immunocompetent Adult

Arcanobacterium haemolyticum is a gram-positive bacillus that is most commonly implicated in pharyngitis and infections of the skin and soft tissue. Systemic and deep-seated infections caused by this organism are rarely reported in the literature. Recently, we encountered two cases of invasive infections caused by A. haemolyticum. We describe two cases, one with vertebral osteomyelitis with an epidural abscess and the other with a buttock abscess with bacteremia.

Lemierre Syndrome Caused by Arcanobacterium haemolyticum Alone in a Healthy Man / 전남의대학술지

Arcanobacterium haemolyticum was isolated from the blood cultures of a previously healthy 37-year-old man who met all the criteria of Lemierre syndrome, including a primary oropharyngeal infection, evidence of thrombophlebitis of the internal jugular vein, and metastatic infections. To the best of our knowledge, this is the first case of Lemierre syndrome caused by A. haemolyticum in Korea and shows that A. haemolyticum alone can cause Lemierre syndrome.

Lemierre Syndrome Caused by Arcanobacterium haemolyticum Alone in a Healthy Man / 전남의대학술지

Arcanobacterium haemolyticum was isolated from the blood cultures of a previously healthy 37-year-old man who met all the criteria of Lemierre syndrome, including a primary oropharyngeal infection, evidence of thrombophlebitis of the internal jugular vein, and metastatic infections. To the best of our knowledge, this is the first case of Lemierre syndrome caused by A. haemolyticum in Korea and shows that A. haemolyticum alone can cause Lemierre syndrome.

Evaluación citológica y microbiológica de lavados uterinos en bovinos con problemas reproductivos (estudio preliminar) / Cytological and microbiological evaluation of uterine washing of bovine with reproductive problems (preliminary study)

Objetivo. Determinar las características citológicas y microbiológicas de lavados uterinos de bajo volúmen en hembras con problemas reproductivos en dos hatos del Altiplano Cundiboyacense. Materiales y métodos. Se evaluaron 21 muestras de lavados uterinos de vacas con historia de problemas reproductivos procedentes de dos hatos lecheros, en el primer hato ubicado en Sibaté (Cundinamarca) se muestrearon 10 animales y en el segundo ubicado en Ventaquemada (Boyacá) se obtuvieron las 11 muestras restantes. Se realizó evaluación macroscópica y microscópica de cada uno de los lavados uterinos; para la evaluación citológica se utilizaron las tinciones de Gram y Wright. La determinación de la flora bacteriana se realizó mediante técnicas estándar en microbiología para la identificación de bacterias no exigentes, adicionalmente se realizaron pruebas de sensibilidad por la técnica de difusión de Kirby-bauer. Resultados. En la citología se observaron bacilos y cocos gram positivos, células epiteliales de descamación uterina (CEDU) y respuesta inflamatoria (RI) mediada por polimorfonucleares (PMN). Los aislamientos bacterianos correspondieron a Lactobacillus sp como flora bacteriana normal del tracto genital (16.66%) y Klebsiella sp como flora acompañante (16.66%); adicionalmente se aislaron bacterias patógenas causantes de problemas reproductivos como Streptococcus sp. β hemolítico (33.33%), Streptococcus sp α hemolítico (50%) y Streptococcus sp. γ hemolítico (50%) y Arcanobacterium pyogenes (Corynebacterium-Actinomyces pyogenes) (16.66%); en un 9.52% de las muestras se observaron espiroquetas. Conclusiones. Se observó una relación directa entre el aspecto macroscópico de los lavados uterinos, la respuesta citológica y el aislamiento de bacterias.

A Case of Arcanobacterium haemolyticum Bacteremia and Osteomyelitis Diagnosed by 16s rRNA Sequencing

Arcanobacterium haemolyticum is a catalase-negative, aerobic gram-positive rod. It causes pharyngitis, skin and soft tissue infection, osteomyelitis, endocarditis, meningitis, pneumonia, and septicemia. We experienced a case of A. haemolyticum bacteremia and osteomyelitis in a diabetic patient. The organism was misidentified as Cellulomonas species by automated system but correctly identified as A. haemolyticum by 16s rRNA sequencing.

Pleural effusion and cardiac displacement in a heifer: a case report

A 16-month-old Holstein heifer with a history of anorexia and respiratory distress was referred to the Veterinary Research and Teaching Hospital of Tehran University. Heart and lung sounds were inaudible on the left side but greatly increased on the right side. On electrocardiography [ECG], decreased amplitudes of ECG parameters were observed. Ultrasonography results revealed a pleural effusion with fibrin deposition. After the removal of 30 liters of pleural fluid, the amplitudes of the P, QRS, and T complexes increased markedly, and heart and lung sounds on the left side gradually increased. Archanobacterium pyogenes was isolated from bacteriological cultures of the pleural fluid. According to the clinical and paraclihical findings, cardiac displacement due to pleural effusion was diagnosed

A Case of Necrotizing Fasciitis Due to Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a Dog-bitten Patient with Diabetes / 대한진단검사의학회지

We report a case of necrotizing fasciitis involving Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a 36-yr-old female diabetic patient, which started after a minor dog bite to the toe of the patient. This case suggested that a trivial infection after a minor dog bite in an immunocompromised patient such as diabetes patient could result in a significant complication such as necrotizing fasciitis. The life-threatening infection was cured by timely above-the-knee amputation, as well as penicillin G and clindamycin therapy.

A Case of Subacute Infective Endocarditis Caused by Arcanobacterium haemolyticum in a Patient with Mitral Valve Prolapse

Recently, we experienced a case of subacute infective endocarditis caused by A. haemolyticum on mitral valve prolapse complicated with systemic emboli, which was successfully treated with antibiotics and valve replacement surgery. To our knowledge, this is the first report to address infective endocarditis caused by A. haemolyticum in a immunocompetent patient who had mitral valve prolapse and survived with successful treatment. Greater awareness of this uncommon organism is needed to make an accurate diagnosis and perform a better clinical management in the early stage of the disease. Recommendation for the treatment of septic A. haemolyticum infections has not been established. Therefore, the treatment should be based on clinical experiences and in vitro susceptibility profiles of the individual strain. The site of infection as well as antimicrobial susceptibility profiles should be considered for appropriate antibiotics choice and decision to perform a surgical intervention.

A Case of Subacute Infective Endocarditis Caused by Arcanobacterium haemolyticum in a Patient with Mitral Valve Prolapse

Recently, we experienced a case of subacute infective endocarditis caused by A. haemolyticum on mitral valve prolapse complicated with systemic emboli, which was successfully treated with antibiotics and valve replacement surgery. To our knowledge, this is the first report to address infective endocarditis caused by A. haemolyticum in a immunocompetent patient who had mitral valve prolapse and survived with successful treatment. Greater awareness of this uncommon organism is needed to make an accurate diagnosis and perform a better clinical management in the early stage of the disease. Recommendation for the treatment of septic A. haemolyticum infections has not been established. Therefore, the treatment should be based on clinical experiences and in vitro susceptibility profiles of the individual strain. The site of infection as well as antimicrobial susceptibility profiles should be considered for appropriate antibiotics choice and decision to perform a surgical intervention.

A Case of Arcanobacterium haemolyticum Sepsis / 대한진단검사의학회지

Arcanobacterium haemolyticum is a beta-hemolytic coryneform bacillus. It has been implicated as an etiologic agent of non-streptococcal pharyngitis and less frequently a cause of skin and wound infections, osteomyelitis, pneumonia, endocarditis, sepsis, and central nervous system infections. We describe a case of A. hemolyticum sepsis reported for the first time in Korea. A 61-year-old man with a diabetic foot was admitted due to a high fever. Three sets of blood cultures taken at the emergency room yielded coryneform bacilli. The organism was beta-hemolytic on blood agar plate, catalase-negative, and non-motile. It was identified as A. haemolyticum by Rapid CB Plus (Remel, Kansas, USA) and API Coryne (BioMerieux SA, Marcy l`Etoile, France) and confirmed by CAMP inhibition reaction. It was susceptible to penicillin, ceftriaxone, erythromycin, ciprofloxacin, and vancomycin by the disk diffusion method using the breakpoint criteria of National Committee for Clinical Laboratory Standards for streptococci other than Streptococcus pneumoniae. The patient was improved with partial amputation of the right big toe and antimicrobial therapy with ampicillin/sulbactam. If Arcanobacterium is isolated from normally sterile sites or culture specimens properly collected from infected tissues, it should be identified to the species level. Commercial biochemical test kits specialized in corynebacteria and CAMP test are useful for species identification of A. haemolyticum.

Five Cases of Arcanobacterium haemolyticum Isolated from Skin Ulcer and Peritonsillar Abscess / 대한진단검사의학회지

Arcanobacterium haemolyticum is a cause of chronic skin ulcers in diabetic patients and respiratory infection, especially pharyngitis in healthy person. Less frequently, it is a cause of osteomyelitis, meningitis, pneumonia, abscess, endocarditis and sepsis. We isolated A. haemolyticum from 5 patients including foot or back ulceration in 3 diabetic patients, wound on calcaneus in a chronic osteomyelitis patient and peritonsillar abscess in a pharyngitis patient. A. haemolyticum is usually isolated with other microorganisms and coryneform bacilli which are often considered to be nonpathogenic normal flora or contaminants in wound infections. The correct diagnosis of this microorganism is important for proper treatment and prevention of serious infections.